13777 ROST THI'S.CARD NEAR FRONT OF BUILDING `
i QfRMIT NUMBER
CITY, Or:'CUPERTINO
INSPECTION,DIVISION 13777
JOB INSPECTION•RECORD
�( ' - ,o - '•'� PERMIT EXPIRATION '
JOB ADDRESS `ray UoS�� �ifls�'./�U.Cr''C7=� UNIT# 1 LOT# / (' �' "
/� '� �� PERMIT EXPIRES IF WORK
OWNER.' y�cw"Q,c' "�I ' /N C.3 _ CONTRACTOR _ AS-NOT STARTED WITHIN
INSPECTIO DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT,ISSU-
FOUNDATION ANCE OR 180 DAYS FROM''
LAST CAL LED INSPECTION.
UFER
- - PERMIT VALIDATION,
PREGUNITE _
POUR NO CONCRETE UNTIL ABOVE'HAS BEEN SIGNED
UNDERGROUND /SLAB
,. PLUMBING 0_
ELECTRICAL, •E NCE DATE
MECHANICAL - B ECT' IPLG. MECH,
_ 111
DON T poiln riOOK UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION - $IFT.
-PLUMBING
MECHANICAL •
PERMIT TO
ELECTRICAL - •�, moi w L
FRAMING -
INSULATION - STORIES TVPECONSTR,
S
OCCGROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' 1
ROOF 5(].1'L FLOOH AREA TOTAL ACREAGE
DIAPHRAGM 4 '^
BUILDING USE
p '' AES INO -CON - PB ON...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED I - 1:1 ' 1:1 [:] !.D
ASSESSORS PARCEL NO.
. • ROUGH ' i ....?.i''
-
PLUMBING i •' y d.y'� .
11 ' I -TRACT NO. PARCEL NO.
LASTEST.- ' s_
+ MECHANICAL 1 ACC.DATE ACC.FILE N0.
ELECTRICAL _ - FINALS DATE INSP.
'FRAMING - SANE
# '
r I , ZONING, NG.$ITE NO. 1
,INSULATION PLUMBING GAS
- - FIRE SPR INK ENIiRGV L]4 ,
MECHANICAL i • '
COVER NO WORK UNTIL ABOVE HASBEEN SIGNED HEATING /, _
LATH-INTERIOR - 7- ^-Q$ ELECTRICALS' FLOOD zorvE acus.
LATH-EXTERIOR - -2 , FIRE DEPT. ' Y❑ No y ❑ N❑
SHEETROCK GRADE - - FEE SUMMARY, -
' - SHEAR INTERIOR ' '-.I $ BUILDING• �.
SHEAR EXTERIOR , — _ TEMPORARY APPROVALS, BULDiNG '�
FIREWALLS ELECTRIC PLAN CHECK.
r - GAS' FEE NO TAPE ORP ASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY ISEISMIC FEE / c•(% .
OCCUPANCVOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDINGINSPECTOR. MICROFILM
ARRANGE FOR'INSPECTION BY PHONING 252-4505," " ELECTRIC /J
HONE WORKING+DAY BEFORE REQUIRED INSPECTION., PLUMBING,—
z� E PLEASE GIVE JOB ADDRESS WHEN PHONING.' „
- SEE PERMIT FOR EXPIRATION DATE.- t' MECHANICAL J
rIMPORTANT! # CONST.TAX
PLEASE READ REVERSE SIDE BEFORE'' "1, TOTAL /' '''�'J
'' CALLING FDR•FINAL INSPECTION.
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• PERMIT NUMBER
BUILDING PROJECT lDENTIFICATION APPLICATION & PERMIT
AD"OWG 11524 �SlansetSpPip;I,rings Court ' 13777
ADDRESS I I
BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
JI-at 7C-ow"en's;• - PLAN CHECK VALIDATION
NAME - - OTY. ELECTRIC PERMIT FEE
r r PHONE
NAMERAcroR s. J�L OUTLETS-SWITCHES•RECEP 10.00/1.00 I I aI-
r r Uc.NO, LIGHTING FIXTURES 10.00/1.00 s
roNTRacroRs "CuPPLIANCES-RESIDENTIAL 4.00 I
• ADORE„ 220 Twin Dolphin Dr. , •,
Rpdwnod City CA PHONE ( PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE
OR ENGINEER Aram Bassenian, A. I .A.
LIC,NO! SIGNS TRANS. 3.00
URE55 E"G 3990 Westerly Pl „ #170 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
A
iIP EMP.METER OR POLE INS. 20.00
ADDRESS u u MOTORS SEE F.EE SCH. �
ADDRESS 220 Twin DolphRparh,in Dr: '. Rpdwnnd City, CA ,. C -
SERVICE CHANGE 20.10AZZ
-2 LICENSED CONTRACTORS DECLARATION �J/(�7
•< 0 w 1 hereby affirm that I am licensed under provisions of Chapter 9' ISSUANCE OAT/E
w a N (commencing with Section 7000)of Division 3 of the Business and i BLDG. ELECT. PLG. MECH.
F w z, Professions Co ,and my license is in full fared app p([�o�
o Z w W License Class_ Lia Number=#3US/ _
Dole _ �Contmctor
er x E -1 I - BUILDING PERMIT
¢ ¢ w OWNER-BUILDF.R DECLARATION INFORMATION
X
000 N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
1e 3 0 ¢ Law for the following reason.(Sec.7031.5,Business and Professions pERMFT ISSUANCE 10.00 O VALUATION $/FT.
; -1 Code:Any city or county which requires a permit to construct,alter,- - L[
Qm > ELEC. LIC.NO.
a 4 o improve,demolish,or repair any structure,prior m its issuance,also EL C. i
as
u require,the applicant for such permmth
,to(lie a signed stateent at TOTAL I PERMIT TO
w $ he is licensed pursuant to the provisions of the Contractor's License
i ���w�
HzLa. with Section 7000)0 f Division 3 of0le ,
4 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT .FEE
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant In a civil penalty �� �( '
of not more than five hundred dollars(S500)J: ALTER-DRAIN& VENT-WATER (EA.) 5.00 -QV�- V
' r ❑ 1,as owner of the property,or my employees with wages as BACK FLOW'PROTECT.'DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAIN$-FLOOR,HOOF,AR EA,COND. 5.00 �- 3 /
Code:The Contractor's License Law does not apply to an owner of
property who'builds or improves lherenn,and who does such work13 FIXTURES-PER TRAP '5.00 S SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
u ar '-
menu not intended or offered for sale.If,however,the building GAS-EA.SYSTEM11NC.4OUTLETS 6.00
't� or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove lot purpose nfsalc.). '1 INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
- ❑ 1,as owner of the property,am exclusively contracting with - ❑ ❑ '❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 6, b g55E5SOPOARCELNO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 -36 6-7-3 3 133
contracts for such projects with a cootnretor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ I Ann exempt under Sea ,B.&P.C.far this
reason WATER HEATER W/VENT 6.00 p
-
Owner Duro WATER SYSTEM, , .5.00 ACC.DATE ACC.FILE NO.
WORKFRS'COMPI:NSAT1ON DECLARATION WATER TREATING EQUIP. -5.00
I hereby affirm that I have certificate of consent to sell=insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
_ copy lhercof(Sec.3900,LabC - -
PolicyNo. CompanWn-i_ted_P-ac%Re-li.anc
0' ❑ Cenifled copy. here by furnished. 1 FIRE BPRINK ENERGY T 2
Z Z �i] Certified;XIIIIIc IcJ the city inspection division. MISC- REFER TO ORD.
O Applicant_ _ Y ❑ N❑ Y❑ N❑
Cr tiPERMIT ISSUANCE 10.00
Cr - CIiRTI EIC E EXEMPTION PROM WORKIiRg• FLOOD ZONE A.L.u.C.
W 1 COMPEE NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. -
? Z( T'his section need not he completed if the Permit is lin one - TOTAL Y❑ N[3Y❑ N[]
hundred dollars($100)or less.)
U O I certify that in the performance of the work]or which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not ennploy any person in any manner so as to
O Do become subject ID the Workers'Compensation Laws of California.
d
Date a ApplicumALTER OR ADD TO MECH. 5.00 BUILDING S4
} N NOTICE'f0 APPLICANT: If,after making this Ccrtificmc of F. ? emanon,you should become subject to One Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of-the Labor Code, you must forthwith comply,with FEE - V
U such provisions or this permit shall,be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
- the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). I HEATING UNIT(TO 100,000 B.T.U.)- 8.00
Lender's Adde�e-CL.1"1_t�LPa HEATING UNIT(OVER 100,000B.T.U.0.50
Lender's Ad_drcss.Sa-R-- 'a-'��1y('�'G CO-CAQ ELECTRIC lP
i certify that I have rea�dnis applI ion U?d stale Thal the above N VENTILATION FAN (SINGLE) 4.00 -
infonnntion'is correct. Ingrcc to comply with all city and county PLUMBING
ordinances and state laws relating to building:construction, and I BOILER-COMP(3H.P.or10o,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMPAOver 100,000 BTU)SEE FEE BCH. MECHANICAL 6
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD. p
Cupertino against liabilities,judgments, costs and expenses whCONST.ich TAX '0 O
may in any way accrue ai inst said City in consequence f the PERMIT ISSUANCE 10.00 t z
grantingo p nit. - / MECH.CONT. - LIC.NO. MECH. '
�• s0197 TOTAL i TOTAL SSS3O
Signature pplicunl/Conlracfor I to (�L a4 -
OFFICE COPY. '